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Critical care
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AceOfHearts<3 specializes in Critical care.

"It's your choice, Ace. People can live a hundred years without really living for a minute."

AceOfHearts<3's Latest Activity

  1. AceOfHearts<3

    Acronym - WEOD

    I was about to say the same about fresh cider donuts! I grew up close to an orchard. Now, if someone was kind enough to get a box of donuts from Dunkin on the way in to work then I totally go for the plain donut with the chocolate frosting and sprinkles on top 🙂
  2. I rather have a nurse be a little nervous coming off orientation rather than being cocky. Take a deep breath- as others have said, you wouldn’t have made it this far if you weren’t capable. Just be alert and never be afraid to ask for help- run a scenario past another coworker, ask for another set of eyes, etc. Patients are better off with a nurse that is cautious than a nurse that is arrogant and overly confident. You got this!
  3. I’m not old, but I don’t like doing someone else’s work, especially when they cock an attitude. I love having students with me and teaching, but I don’t like someone posting and expecting detailed written answers. Good luck on reddit- won’t miss YOUR arrogance here.
  4. AceOfHearts<3

    How do I trust my judgement after this? First Patient Death

    We can’t save everyone, despite our best efforts. GI bleeds are particular beasts that can rear their ugly heads hard and fast. Some times we know a patient is decompensating but we don’t know why or we can’t stop it. Please look into using your EAP. You did the best you could and it is not all on you. Sending hugs.
  5. This is a dangerous practice for several reasons as others have stated. It’s very rare for me as an ICU nurse to hold someone’s beta-blocker if it’s ordered and when I do I have a discussion with the team notifying them. There are many reasons for this, but many times the med is not just for “BP control” and putting someone into beta-blocker withdrawal is a very real concern. If a med is being held regularly that is something the provider needs to be aware of- can the dose or frequency be reduced? Can another similar med be prescribed, etc. are all things that need to be considered. Holding meds without hold parameters is also considered practicing medicine and The Joint Commission would have a field day with this.
  6. AceOfHearts<3

    Nurse vs respiratory

    That might be the way it is done at YOUR facility, but it does not mean that is how it is done at every facility. You never having administered a neb does not mean other nurses don’t or can’t. At one hospital I’ve worked at just RT gave the nebs and any breathing treatment- including inhaled capsules like spiriva (a patient swallowed the capsule one time as they were confused). At another hosiptal the RT rounds on new admissions and every X amount of days or with new therapy being started, but the patient’s RN is responsible for administering 95% of the nebs/treatments. I’m in the ICU where RT does all the treatments and always need to remind myself to give the nebs when I’m pulled to the floors to help.
  7. AceOfHearts<3

    Scab nursing?

    My area is already struggling with hospitals being on overflow. It’s not feasible or possible for a whole hospital to shut down and transfer out their patients to other hospitals- the beds aren’t available. Patients still need the care, so when nurses strike there will be scab nurses. If workers of a large retailer, such as Target, were union and went on strike there would be no way to justify scab workers in that scenario- they’re not essential personnel and not being able to go to Target is not going to possibly result in death (although many people, myself included, would be lost and in withdraw). I don’t live in an area with many unions, so a nurses strike would be very very rare. My facility is not union, so this isn’t a situation I have to worry or be concerned about.
  8. AceOfHearts<3

    "Nurses Eat Their Young"

    I’ve worked on a couple units in a couple hospitals and there has been no eating of the young in any of the places. I’m in critical care where we have very opinionated type A personality nurses, where I feel like eating the young would be more prevalent if it were an issue, and it isn’t. I agree with the above posters- some people just suck and sometimes we unfortunately work with them. It happens in every field/profession/job.
  9. AceOfHearts<3

    How to effectively delegate in nursing on a unit

    I always liked to demonstrate to the aides that I wasn’t just pushing stuff off on them. ”Hi Ann Aide, Mrs. Smith in room 1 needs to use the bathroom. Can you please assist her while I give Mr. Brown his medication before he goes to physical therapy off the floor. Also, I’m sure Mrs. White in room 3 has been incontinent again and is due to be repositioned- I know she’s a heavy 2 assist so let’s tackle that together and I can assess her skin at the same time”
  10. AceOfHearts<3

    pH in NGTs

    We use X-ray to confirm placement and we always chart how far it is advanced-such as right nare at 60. We then assess aspirate characteristics and that the tube is in the proper spot by the measurements. If the NG tube is for gastric decompression and it’s an emergency then we’ll go off aspirate characteristics. I’ve placed an NG tube for decompression and before I could even hook it up to suction it has had gastric contents backing up into it. Cases like that the risk of the patient vomiting and aspirating is so high that we’ll hook it up to suctioned without X-ray confirmation.
  11. The quote button is not working. The reply below is in response to: “Based my recent experience, no, I don't think anyone is safe. Am only carrying drivers liscence car insurance and maybe 15$ to work now. Also had to put my sweet old collie dog down literally a week ago after this happened. Am I deranged for wondering what's happening to this world? Is nothing sacred? Why try to have anything if it can be taken so thoughtlessly?.” Don’t forget your medical insurance card too. I’ve been seriously hurt on the drive to work before. I don’t leave the house without it.
  12. AceOfHearts<3

    Crying at work

    I’m an ICU nurse. I’ve had a patient that I knew something more was going on with and I made that known. I watched him like a hawk and just had a feeling something horrible was going to happen. A couple of days later when I wasn’t at work it happened-the patient crashed and crashed bad. When I found out the next shift I worked, I had an ugly cry in the car on my way home from work. Sometimes there is more we can do and other times we just have to wait for the milk to spill and clean up the mess.
  13. AceOfHearts<3

    Need some advice. Asked to do pedi nursing.

    I would say you don’t have experience with pediatric patients. I would also add that they are not just smaller versions of adults- they are their own specialty- and they should have/want a nurse with experience in peds. ”I’m sorry, I just don’t have the experience with the pediatric population that you should want and expect. Thank you for the offer though, it is very flattering.”
  14. AceOfHearts<3

    Obtaining Supplies School Project

    Most of the time we have what we need. It’s very frustrating when we run out of basic supplies and it appears the supply person isn’t doing their job properly. It’s irritating to have to search for a new pulse ox or call a million times when we need more masks or gowns for an isolation room. Sometimes the linen cart doesn’t get refreshed and we run out of gowns and wash clothes. It’s pretty hard to give meds through an NG tube without a syringe or clean a patient up if there is no soap. These are things we use on a regular basis everyday and we should never run so low that we run out- we normally have plenty to spare because they are basic items in the ICU.
  15. AceOfHearts<3

    BLS renewal—ouch

    I avoid doing compressions if at all possible because it exacerbates an old injury. I can do them and certainly jump in and do my share when needed, but I tend to pick other roles otherwise I tend to be in severe pain for several days. Daisy- I feel like the in-person renewal portion for BLS is way worse than ACLS.
  16. AceOfHearts<3

    Written Up

    Don’t worry, The Joint Commission is now cracking down on this. Any duplicate therapy PRN medications must clearly state what to give and when. This applies for anxiety, pain, bowel regimen meds, etc. and without very clear cut directions, per TJC, it is out of the scope of our practice to decide what to give the patient. So the order will need to say give Med A first and 2 hours later if no relief give Med B. Or something similar to that depending on the meds and indication.